Maturation of Anterior Cruciate Ligament Graft—Possibilities of Surgical Enhancement: What Do We Know So Far?

Abstract

The purpose of this study is to review the surgical methods of enhancing anterior cruciate ligament (ACL) graft maturation. Several methods of ACL maturation enhancement were identified through research of the literature available in the PubMed database. ACL remnant preservation was the most extensively investigated technique. ACL reconstruction with a pedunculated hamstring graft provides superior revascularization of the graft along with higher mechanical strength. The usage of a graft enveloped with a periosteum was proposed to enhance the tendon-bone unit formation, and consequently, to prevent the bone tunnel widening. The muscle tissue on the graft is a potential source of stem cells. However, an excessive amount may weaken whole graft strength despite its enhanced remodeling. Similarly, amniotic tissue may augment the ACL reconstruction with stem cells and growth factors. Despite the existence of several surgical techniques that utilize amnion, the outcomes of these augmentation methods are lacking. Lastly, the intra-articular transplantation of the synovium on the surface of an ACL was proposed to augment the graft with synovial tissue and blood vessels. In conclusion, diverse approaches are being developed in order to enhance the maturation of an ACL reconstruction graft. Although these approaches have their foundation in on well-established scientific research, their outcomes are still equivocal. Clinical trials of high quality are needed to evaluate their utility in clinical practice.

Biomechanical considerations for graft choice in anterior cruciate ligament reconstruction

“…There are several different types of hamstring-based grafts that are commonly used in ACLR, but this review will mostly focus on the gracilis and semitendinosus quadrupled graft (GST4), which is a four-stranded graft made from the semitendinosus and gracilis tendons and associated muscle ( 37 ). Graft diameter and length are two important variables in hamstring autograft that have biomechanical consequences.…”

Both arthroscopic and open posterior knee capsulotomy are effective in terms of extension recovery and functional improvement—systematic review

“…and M.M.) using a predefined extraction form [4]. The extracted data included information regarding study design (authors, year of publication, level of evidence), patient characteristics (quantity of patients, mean age, sex distribution, pre‐existing surgeries/conditions, and interval between those conditions and capsulotomy), surgical technique (arthroscopic versus open, posteromedial versus posteromedial and posterolateral, others), outcomes (length of follow‐up, preoperative and postoperative range of motion, functional outcome scores, and quantity of patients with persistent extension deficit) and complications.…”

“…Registration in the Prospero International Prospective Register of Systematic Reviews with a registration number CRD42020221297 was performed in November 2020. The review was conducted according to predefined systematic review protocol [4].…”